Predicting Suicidality Using a Computer Adaptive Test: Two Longitudinal Studies of Sexual and Gender Minority Youth

Objective: Over the past decade, rates of death by suicide have increased among youth. Efficient and effective screening approaches are needed for suicide prevention. Sexual and gender minority youth (SGMY) experience profounddisparities,but little isknownabout subgroups andriskassessmentsneedtobevalidated.This studytested the psychometric properties and predictive value of a highly efficient computerized adaptive test for suicide risk (CAT-SS) among SGMY. Methods: Participants in two cohort studies of SGMY completed the CAT-SS and validated measures of suicidality in 2018 (n = 1,073) and at their follow-up visit 6 months later (n = 936). Tests of psychometrics and predictive validity were performed. Results: Younger, assigned female at birth, nonmonosexual (e.g., bisexual; relative to monosexual), and gender nonconforming or nongender binary (relative to cisgender and transgender) participants had significantly higher CAT-SS scores.None of theCAT-SS itemsmet the threshold for differential item functioning. In longitudinal analyses, prediction of suicidality moved from poor to good accuracy onceCAT-SSwas included in themodel.CAT-SS significantly improved prediction of suicidality over-and-above reported suicidality at a prior wave. Conclusions: The current study validated CAT-SS as a brief predictor of suicide risk in the disproportionately affected population of SGMY. Screening of SGMY in clinical and community settings usingCAT-SS could allowfor the identification of participants that need services to reduce their risk of future suicide.Results support the need for particular attention to suicide prevention among SGMYwho are teenagers, assigned female at birth, nonmonosexual, and gender nonconforming or nongender binary.